The Lived Experience of Parents of Children and Youth With Special Healthcare Needs on Public and Private Insurance: A Phenomenological Study

PURPOSE OF THE STUDY

The number of children and youth with special health care needs (CYSHCN) is steadily growing in the United States. There are significant differences between private and public health plans in terms of cost, adequacy, and parent satisfaction. The purpose of this study was to understand the experiences of parents with CYSHCN enrolled in public and private insurance with or without a nurse care coordinator. This study also sought to understand parents' experience of support.

PRIMARY PRACTICE SETTING

The primary practice setting was participants' choice of location.

METHODOLOGY AND SAMPLE

A qualitative descriptive design was used with 16 parents of children and young adults aged 2 to 21 years. Semistructured interviews were used, and Colaizzi's (1978) eight steps was the selected interpretive method.

RESULTS

Five themes emerged for parents navigating their child's insurance in the presence or absence of a nurse care coordinator: (1) Struggle with Self-Preservation, (2) Abandonment and Isolation, (3) Self-Reliance and Advocacy, (4) Interdependence, and (5) Lifeline. These themes were also dependent on the type of insurance and sources of support available.

IMPLICATIONS FOR CASE MANAGEMENT PRACTICE

Models centered on care coordination can also be used as a mechanism to guide nurse care coordinators in practice. Providing care coordination support could help lessen the caregiver burden especially while navigating public or private insurance. Results highlighted how insurance companies can make potential changes within the health plan infrastructure. Incorporating nursing care coordination activities not only results in health care savings for the health plan but also improved health outcomes for its enrollees.

Predictors and social determinants of HIV treatment engagement among post-partum Black women living with HIV in southeastern United States

AIM

Guided by Mcleroy's socio-ecological model, this study explored the predictors and social determinants of HIV treatment engagement among Black post-partum women living with HIV.

METHOD

Quantitative, research methodology.

DESIGN

We conducted a retrospective, secondary data analysis of 143 Black post-partum women living with HIV who received peripartum care in South-Florida, United States, from 2009 to 2017. We examined odds of immediate post-partum engagement at 3 months post-partum, and ongoing primary care engagement at 12 months post-partum.

RESULTS

The independent group analyses showed low levels of immediate post-partum (32.9%) and ongoing primary care engagement (24.5%). At the intrapersonal level, maternal prenatal health significantly affected both immediate post-partum and ongoing primary care engagement; and at the interpersonal level, HIV disclosure and intimate partner violence/abuse significantly affected immediate post-partum engagement. Also, immediate post-partum disengagement was a significant predictor for ongoing primary care disengagement.

CONCLUSION

This study provides timely and critical information to address recent calls for awareness and interventions to address issues on health disparities and inequities among racialized communities.

IMPACT

The study provides significant evidence on the effects of social determinants of health on health outcomes for Black women living with HIV. Critical understanding and assessment of these factors, together with proper, proactive interventions may help to gauge such negative effects. Healthcare providers taking care of Black women living with HIV ought to be cognizant of these factors, assess at-risk women and intervene accordingly to ensure that their care is not marginalized.

PATIENT/PUBLIC CONTRIBUTION

This study includes direct patient data from Black post-partum women living with HIV who were seen at prenatal and post-partum clinics wherein data for this study were obtained. The study results were presented locally, nationally and internationally to communities, organizations of healthcare providers, stakeholders and service-users, who further corroborated our findings, and provided insights and future recommendations.

Psychological distress, social support, and family satisfaction among family members of non-COVID-19 critical care patients: A cross-sectional study

PURPOSE

This study aims to explore the associations among psychological distress, perceived social support, and family satisfaction among family members of non-COVID-19 intensive care unit (ICU) patients during the COVID-19 pandemic.

DESIGN

A cross-sectional study.

METHODS

Family members of patients with at least 48 h in the ICU and without a COVID-19 diagnosis were screened between January and March 2021. For enrolled ICU family members, five questionnaires for perceived stress (Perceived Stress Scale), anxiety symptoms (General Anxiety Disorder-7), depressive symptoms (Patient Health Questionnaire-9), perceived social support (Medical Outcomes Study Social Support Survey), and family satisfaction (Family Satisfaction with Care in the Intensive Care Unit-24) were administered by phone either in English or Spanish language. Sociodemographic and patient clinical data were also collected. Data were analyzed using descriptive statistics, Pearson's correlations, Mann-Whitney U, and Fisher's exact tests.

FINDINGS

Of 87 eligible ICU family members, 63 were enrolled (72.4%); 27% of the sample presented with clinically significant symptoms of anxiety, 25.4% with depression, and 76.2% had a high perception of social support. ICU family members with low/fair perceived social support reported statistically significantly higher perceived stress and lower family satisfaction. Perceived stress was negatively correlated with family satisfaction. Clinically significant symptoms of anxiety and depression were not statistically associated with family satisfaction or perceived social support.

CONCLUSIONS

While ICU admission-related stress may undermine family satisfaction, perceived social support may be positively associated with the way that ICU family members of non-COVID-19 patients evaluate the quality of care in the ICU. Knowing the factors that influence family satisfaction in the ICU may assist stakeholders and policy developers to improve family-centered care in the hospital setting.

CLINICAL RELEVANCE

Early screening for psychological distress and social support levels during admission should be included in updates of visiting and communication policies in the ICU. Prompt identification of family members at risk of a poor ICU experience may enhance efforts to support them, particularly in acute care settings where differentiated approaches to COVID-19 and non-COVID-19 ICU family members are established.

Relationships Between Colorectal Cancer Survivors' Positive Psychology, Symptoms, and Quality of Life

This cross-sectional study examined colorectal cancer (CRC) survivors' symptom and symptom cluster characteristics (occurrence, frequency, and severity), positive psychology (benefit-finding and post-traumatic growth), and quality of life (QoL), and determined whether positive psychology moderates symptoms and QoL relationship during acute cancer survivorship, time from diagnosis to treatment completion. A total of 117 CRC survivors completed demographics, symptoms, QoL, and positive psychology questionnaires. Descriptive statistics, multiple linear regression, and moderation analyses were performed. Participants reported high QoL (94%, M = 5.15) and moderate-high positive psychology (75%, M = 3.21). Nineteen symptoms and five symptom clusters were inversely related to QoL (p < .05). Positive psychology (M = ~≥3.24) moderated the relationship of QoL (p < .05) with symptoms occurrence (n = 10), symptom severity (n = 1), and with the generalized symptom cluster (weakness, fatigue, dizziness, drowsy, sleep disturbances, and pain). Positive psychology aids in symptom management and improves QoL. Nurses are poised to identify, prevent, promote, and advocate self-management skills to improve health-related outcomes.

Family Rejection During COVID-19: Effects on Sexual and Gender Minority Stress and Mental Health Among LGBTQ University Students

This study examines the relationship between family rejection and moderate to severe psychological distress during COVID-19 among LGBTQ university students. Data were obtained from a national cross-sectional electronic survey of LGBTQ university students (N = 565) collected in the summer of 2020. Hierarchical logistic regression models were used to examine the predictive association between increased family rejection and moderate to severe psychological distress. Respondents who reported increased rejection were more than twice as likely to report moderate to severe psychological distress, with social isolation and LGBTQ identity concealment being significant covariate predictors in the model. These results demonstrate the importance of public health, medical, mental health, and higher education stakeholders understanding the significance of LGBTQ-identity related family rejection when addressing the mental health and well-being of LGBTQ young people.

Hypertension and Diabetes Mellitus in Rural Haiti

Introduction: The problem of the prevailing occurrence of hypertension and diabetes cases quickly took the world by storm. Rural areas became even more exposed to the negative issues associated with these health conditions due to the lack of a skilled workforce and educational programs for patients. Within the framework of the current paper, the researcher utilized the data from two mission trips in Thomonde, Haiti, to gain more insight into chronic health issues among rural Haitian residents. Methods: This study employed a retrospective analytical cross-sectional retrospective, descriptive design utilizing data obtained from two mission trips in Thomonde, Haiti in the areas of Palmay, Savane Plate, and La Hoye. The information was analyzed with the help of the SPSS software. A total of 403 adult patient visits across the three sites and two visits were included in the analysis. Results: Gastroesophageal reflux disease (GERD) (25.8%) was the most common diagnosis found in the rural Haitian communes among adults in the total sample (N=403), followed by Hypertension (16.8%) and Dehydration (13.9%). Among women, significant differences were found by location for pregnancy. The greatest number of pregnancies were observed in La Hoye (19.0%). Conclusion: The core implication of these findings was the significance of disseminating knowledge across rural areas while conducting similar retrospective studies to check progress. Real-life application of relevant knowledge could be beneficial for both patients and care providers operating in rural locations that are the hardest to reach.

The significance of breastfeeding practices on postpartum depression risk

OBJECTIVE

Examine the relationship between breastfeeding practices (breastfeeding status and breastfeeding length) and postpartum depression (PPD) risk, after controlling for significant risk factors for PPD.

DESIGN

A cross-sectional, correlational study design was used. Data was used from a national dataset using a subsample of women (n = 29,682) residing in 26 states in the United States that answered the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire. A secondary analysis was conducted using descriptive and bivariate analyses, and a multiple logistic regression model.

RESULTS

Women currently breastfeeding (AOR = 0.87 CI: 0.79-0.95, p = .001), and women who breastfed for longer periods of time (p = < .002) had a statistically significantly lower PPD risk compared to their counterparts, even after accounting for significant covariates.

CONCLUSIONS

Study findings suggest breastfeeding as a cost efficient and healthy behavior that can decrease a woman's risk for PPD. Nurses should educate and promote the maternal mental health benefits of breastfeeding in addition to the health benefits for the infant.

Developing a Measure of the Impact of COVID-19 Social Distancing on Household Conflict and Cohesion

This report introduces the COVID-19 Family Environment Scale (CHES), which aims to measure the impact of social distancing due to COVID-19 on household conflict and cohesion. Existing measures do not capture household experiences relevant to the pandemic, in which families are largely confined to their homes while sharing a life-threatening situation. Using best practice guidelines, we developed a pool of items and revised them with review by a panel of experts, and cognitive interviewing with community respondents. We administered the CHES by online survey to 3,965 adults. The CHES consists of 15 items for each of two subscales, household conflict (α = .847) and household cohesion (α = .887). Exploratory factor analysis yielded two factors, corresponding to the intended conflict and cohesion items, which accounted for 29% of variance. Confirmatory factor analysis partially supported the 2-factor model (RMSEA = .057; CFI = .729, TLI = .708, and SRMR = .098). The CHES also contains 25 optional items to describe respondent and household characteristics, and household-level COVID-19 exposure. The CHES, publicly available at https://elcentro.sonhs.miami.edu/research/measures-library/covid-19/index.html, provides a tool for measuring the impact of the COVID-19 pandemic on important determinants of resilience in the face of major stressful events. Further work is needed to address the factor structure and establish validity of the CHES.

Comparing Educational Outcomes of Online Module-Based Technology with and without Simulation on Attitudes Toward Care of the Dying in Second Semester BSN Students

BACKGROUND

Opportunities to provide competent and compassionate End-of Life (EOL) care to patients and families are limited for nursing students.

METHOD

A mixed methods approach was used to explore the students' attitudes towards caring for an EOL patient in two groups: an on-line-module only group and an on-line module plus simulation group.

RESULTS

Statistically significant effect of time was found across the two conditions (F [1, 69] = 7.83, p = .007), indicating that scores on the FATCOD-B significantly improved regardless of the condition over time. The qualitative responses indicated that the simulation experience was more impactful than the on-line module.

CONCLUSIONS

Innovative education modalities described in the study may assist in preparing the future workforce for the myriad of demands related to health, life, and death.

Implementation of an in-hospital stroke simulation protocol

Purpose A major component of hospital stroke care involves prompt identification of stroke in admitted patients. Delays in recognizing stroke symptoms and initiating treatment for in-hospital stroke can adversely impact patient outcomes. This quality improvement intervention used simulation together with a traditional lecture to instruct nurses at a university hospital about a new stroke protocol being implemented to increase rapid recognition of stroke and meet Joint Commission National Hospital Inpatient Quality Measures. The paper aims to discuss these issues. Design/methodology/approach In total, 86 registered nurses from the neurology and cardiology units attended a lecture and participated in a simulation scenario with a standardized patient exhibiting stroke symptoms. Participants completed a ten-item pre-test to measure their knowledge of stroke care prior to the lecture; they repeated the test pre-simulation and once again post-simulation to evaluate changes in knowledge. Findings Overall mean stroke knowledge scores increased significantly from pre-lecture to pre-simulation, and from pre-simulation to post-simulation. Simulation plus lecture was more effective than lecture alone in increasing knowledge about hospital stroke protocol despite assigned unit (cardiology or neurology), years of experience, or previous exposure to simulation. Research limitations/implications All eligible nurses who agreed to participate received training, making it impossible to compare improvements in knowledge to those who did not receive the training. Originality/value A diverse array of nursing professionals and their patients may benefit from simulation training. This quality improvement intervention provides a feasible model for establishing new care protocols in a hospital setting.

Sexual violence screening practices of student health centers located on universities in Florida

OBJECTIVE

The purpose of this study is to describe current sexual violence screening practices of student health centers located on universities in Florida.

PARTICIPANTS

Institutional level data was collected from 33 student health centers from November 2015 through January 2016. The student health centers were located on public or private universities.

METHODS

A cross-sectional descriptive study design was used. Data was collected from student health center representatives through use of a telephone administered survey.

RESULTS

Findings reveal that the majority of student health centers screen for sexual violence. However, not all use effective screening strategies. Further, the majority of screening questions used are not specific to sexual violence.

CONCLUSIONS

Findings can be used to assist universities with responding to campus sexual violence among the college population. Recommendations for strengthening sexual violence screening practices and future research are provided.

Coming Out Experiences of Hispanic Sexual Minority Young Adults in South Florida

Sexual minority youth and young adults (SMYYA) have higher prevalence of mental and behavioral health problems potentially linked to experiences of discrimination, stigma, and rejection. Among Hispanics, the intersection of stressors related to being an ethnic and sexual minority may result in compounding adverse outcomes. Coming out may play an important role in experiencing discrimination, stigma, and rejection. However, limited research examines coming out among Hispanic SMYYA (HSMYYA). This qualitative study seeks to understand the coming-out experiences of HSMYYA living in South Florida. Twenty participants between 18 and 28 years old were interviewed. Qualitative content analysis generated codes, which were grouped into categories to generate themes. This study presents data highlighting reasons for disclosing and not disclosing sexual orientation and the perceived consequences of those decisions. Additionally, we discuss unique cultural elements that impact HSMYYA's decisions to reveal sexual orientation.

Social Determinants of Depression Among Hispanic Women

BACKGROUND

Depression is the number one cause of disability in the world. Hispanic women are at a higher risk for depression than Caucasian and African American women. This is in part due to multiple social determinants of health that affect the individual, family, aggregates, and community.

OBJECTIVE

To investigate the social determinants of depression among Hispanic women in South Florida.

DESIGN

This is a secondary cross-sectional data analysis. A total of 280 Hispanic women from South Florida between 18 and 50 years of age were analyzed.

RESULTS

Depression is prevalent among Hispanic women in South Florida (37.5%). Education, health status, and living with partner were significant predictors of depression in the sample.

CONCLUSION

Development of a culturally tailored risk assessment tool that highlights the social determinants of depression in Hispanic women is essential, as it could be used as a standard practice in primary care and other appropriate settings.

Development and psychometric evaluation of a condom use self-efficacy measure in Spanish and English

BACKGROUND

Condom self-efficacy is an important construct for HIV/STI prevention and intervention. A psychometrically sound measure of the self-efficacy for using condoms that has been designed for Hispanic women to respond in Spanish or English is needed.

OBJECTIVES

The goal of this study was to develop and evaluate a brief self-report measure of condom use self-efficacy.

METHODS

We developed a 15-item measure of condom use self-efficacy based on expert knowledge of measurement and HIV/STI prevention with Hispanic women using a translation-back translation approach. Participants were 320 Hispanic women from the Southeastern US.

RESULTS

Internal consistency of the full measure was 92. A short form of the instrument with a subset of five items also had acceptable internal consistency, alpha = .80, and was significantly correlated with the full scale, rs = .93, p < .001. A single latent factor explained 9-48% of the variation in these items. Evidence of construct validity of the short form was provided by correlations of the scale with two self-report measures of condom use: rs = .34** with condom use, rs = .37** with condom use during vaginal sex.

CONCLUSIONS

Either the full measure or the five-item measure could be used in studies where condom use is an important behavioral outcome, such as evaluating prevention interventions, with Hispanic women. Future studies should examine the performance of this measure with other groups, including Hispanic men and members of other ethnic and language groups.

Interprofessional Simulation Olympics as a platform to assess team work knowledge acquisition

Introduction

Several years ago an on-stage competition called SimWars was introduced to the simulation community. This concept was adopted into a patient safety course as a way to further engage students and named Sim Olympics. We sought to evaluate it as a platform for assessment of learning in students who participated as audience members.

Methods

A non-equivalent groups design was used to assess whether students could be taught to recognise features of effective teamwork, including a pair of expert raters. One-way repeated measures analysis of variance was used to compare students’ attitudes toward interprofessional education (IPE) education, teamwork and simulation, before and after the course.

Results

Student scores compared to expert scores showed good agreement. For team 1 there were no statistical differences noted (M=19.58, SD=4.34 given by the students, M=17.50, SD=2.12 given by the experts), t (192)=1.26, p=0.264. There was also no difference for team 2 (M=15.173, SD=5.52 given by the students, M=19.50, SD=3.53 given by the experts), t (173)=0.863, p=0.354. A premeasure and postmeasure of students’ attitudes towards IPE education, teamwork and simulation, also showed significant time effect, p<0.001.

Conclusions

Medical and nursing students were able to demonstrate their learning of teamwork dynamics by discerning differences between great teamwork and good teamwork as proficiently as seasoned experts. Findings of this study may further support the use of observation as a method to evaluate learning.

Predictors of HIV enacted stigma among Chilean women

AIMS AND OBJECTIVES

To investigate if socio-demographic factors, religiosity, HIV-related knowledge, Marianismo, history of having been tested for HIV, knowing someone who died of AIDS and HIV risk perception were predictive factors to HIV enacted stigma predictors among Chilean women.

BACKGROUND

HIV infection is the number one cause of death among women during their reproductive years. In Chile, studies with people living with HIV demonstrate the existence of HIV-related stigma. However, limited evidence is available about the underlying causes of HIV enacted stigma that results in stigmatisation and discrimination.

DESIGN

The current cross-sectional study is a secondary analysis of data collected to assess the impact of an HIV prevention intervention (Mano a Mano-Mujer) designed for Chilean women. A quasi-experimental design was used in the original study.

METHODS

This study was conducted in two communities in Santiago, Chile. The sample for this study consisted of 496 Chileans between ages 18-49. Descriptive statistics and multiple regression were used for the analysis.

RESULTS

Participants in the study reported high levels (77·8%) of HIV enacted stigma. Higher levels of HIV-related knowledge were associated with lower levels of HIV enacted stigma. Women with higher education had lower levels of HIV enacted stigma than women with elementary education. In addition, greater levels of marianismo (cultural belief that women should be passive, faithful, and devoted to family) were associated with higher HIV enacted stigma scores.

CONCLUSIONS

The findings reflected the presence of HIV enacted stigma among Chilean women. Identifying the significant predictors of HIV enacted stigma can help the nursing community to design HIV prevention interventions that include the reduction in HIV enacted stigma. HIV evidence-based prevention interventions should incorporate contents related to stigma to contribute to prevent HIV enacted stigma at individual and community levels in accordance with the bioecological model.

RELEVANCE TO CLINICAL PRACTICE

The results of this study could serve to develop HIV prevention interventions that target the reduction in HIV enacted stigma.

Use of virtual clinical simulation to improve communication skills of baccalaureate nursing students: a pilot study

BACKGROUND

According to The Joint Commission (2012), the leading cause of sentinel events in the United States was miscommunication. Lack of thorough and accurate communication remains a serious challenge in healthcare and an educational priority in schools of nursing. Virtual clinical simulation is an online educational approach where students use avatars to practice various skills.

OBJECTIVES

The purpose of this pilot study was to evaluate the educational innovation of using virtual clinical simulation to improve communication skills of BSN students. The objectives of the simulations were to 1) recognize significant patient data and 2) accurately perform the ISBAR communication technique.

DESIGN

The study used a within-group, time-series design with eight students. Students participated in two synchronous virtual simulations in an online virtual clinical environment called CliniSpace. Students performed in groups of four to five students.

METHODS

Students performed in two virtual simulations in groups of four to five students. Student performances were scored by two raters using the CliniSpace ISBAR Rating Sheet. Field notes from debriefing sessions were analyzed for content.

RESULTS

Mean group student performance scores more than doubled from performance one to performance two. This change was found to be statistically significant, p<.001. Field notes revealed that students listened to how their peers communicated and learned from them. Students expressed having less anxiety, knowing what to expect, and having "better flow" with communication. Students verbalized learning to assess the patient prior to calling the physician and to give a recommendation to the physician.